Milestone Pharmaceuticals Inc.
MIST · Pharmaceutical Preparations · 124.5M shares · +4845%/yr ↑ dilution · EDGAR filings ↗
Reference price $2.26 · est. market cap ~$281M — last insider sale, 2026-04-16 (estimated from the dated SEC Form 4 price × shares outstanding — not a live quote)
Grade
C58Newly approved cardiovascular product entering launch with positive trial data, but high leverage and unproven commercialization.
Strengths
- CARDAMYST (etripamil) FDA-approved Dec 2025 with positive Phase 2/3 data (AFib-RVR p<0.0001; PSVT Phase 2 p<0.05)
- Adequate liquidity (current ratio 8.0, ~8.6 quarters runway) and a large addressable PSVT market
Risks
- High leverage (debt/equity 1.37, 90th pct) and very weak returns (ROE -151%, ROA -56%); FCF -$49M, pre-revenue
- Commercial execution unproven; pivotal NODE-301 was a mixed/redesigned readout that missed its original Part 1 endpoint
Notable findings
- Exec changeRecent 8-K item 5.02 8-K ↗
- Cash burnNegative free cash flow (-49.3M)
- Chronic dilutionShare count +4845%/yr over 1y (dilution, book value/share -97%)
- Strong balance sheetStrong balance sheet — $106M cash & investments, ~9 quarters of runway
- Notable holderHeld by 4 notable fund(s): GOLDMAN SACHS GROUP INC, CITADEL ADVISORS LLC, RENAISSANCE TECHNOLOGIES LLC +1 more (as of 2026-03-31)
- AccumulatingInstitutional holders rose 3→5 QoQ (2025-12-31→2026-03-31)
- New fund positionNotable fund(s) opened this quarter: GOLDMAN SACHS GROUP INC, RENAISSANCE TECHNOLOGIES LLC
- Insider sellingInsider selling — 8 open-market sale(s) by 5 insider(s) (cluster of 5 insiders, ~$339,470, last 6mo) Form 4 ↗
Quarterly revenue
Last 2 quarters · from SEC filings.
Key metrics
Return on equity
-151.0%
Return on assets
-55.5%
ROIC
-49.6%
Debt / equity
1.4×
Current ratio
8.0×
Free cash flow
-$49M
EBITDA
-$62M
Tangible book value
$42M
Cash & investments
$106M
Cash runway
9q
Insider transactions · last 18 months
| Date | Insider | Type | Shares | Price |
|---|---|---|---|---|
| 2026-04-16 | Oliveto Joseph | Sell | 36K | $2.26 |
| 2026-01-26 | Muller Lorenz | Option exercise | 20K | — |
| 2026-01-26 | Nelson Jeffrey Edward | Option exercise | 20K | — |
| 2026-01-26 | Nelson Jeffrey Edward | Sell | 12K | $1.93 |
| 2026-01-26 | Bharucha David | Option exercise | 20K | — |
| 2026-01-26 | Bharucha David | Sell | 12K | $1.93 |
| 2026-01-26 | Hasija Amit | Option exercise | 20K | — |
| 2026-01-26 | Hasija Amit | Sell | 12K | $1.93 |
| 2026-01-26 | Muller Lorenz | Sell | 11K | $1.93 |
| 2026-01-26 | Oliveto Joseph | Option exercise | 67K | — |
| 2026-01-26 | Oliveto Joseph | Sell | 35K | $1.93 |
| 2026-01-08 | Oliveto Joseph | Sell | 43K | $2.25 |
| 2026-01-07 | Oliveto Joseph | Sell | 500 | $2.25 |
| 2025-12-15 | Hasija Amit | Sell | 58K | $2.32 |
| 2025-12-15 | Muller Lorenz | Sell | 54K | $2.32 |
| 2025-12-15 | Oliveto Joseph | Sell | 133K | $2.32 |
| 2025-12-15 | Nelson Jeffrey Edward | Sell | 58K | $2.32 |
| 2025-12-15 | Bharucha David | Sell | 58K | $2.32 |
| 2025-12-12 | Bharucha David | Grant | 100K | — |
| 2025-12-12 | Oliveto Joseph | Grant | 280K | — |
| 2025-12-12 | Nelson Jeffrey Edward | Grant | 100K | — |
| 2025-12-12 | Muller Lorenz | Grant | 100K | — |
| 2025-12-12 | Hasija Amit | Grant | 100K | — |
| 2025-12-09 | Muller Lorenz | Gift | 25K | — |
| 2025-07-11 | Hasija Amit | Grant | 50K | — |
| 2025-07-11 | Bharucha David | Grant | 53K | — |
| 2025-07-11 | Wills Robert James | Grant | 50K | — |
| 2025-07-11 | Liebert Debra K. | Grant | 17K | — |
| 2025-07-11 | PAPA JOSEPH C | Grant | 100K | — |
| 2025-07-11 | Oliveto Joseph | Grant | 67K | — |
| 2025-07-11 | Muller Lorenz | Grant | 67K | — |
All non-derivative Form 4 activity (SEC), newest first.
Clinical trials
| Trial | Title | Phase | Status | Primary completion |
|---|---|---|---|---|
| NCT05763953 ↗ | The NODE-202 Study (Study of Etripamil Nasal Spray in Pediatric Patients) Paroxysmal Supraventricular Tachycardia | PHASE2 | Recruiting | 2027-06-01 |
| NCT06716021 ↗ | ReVeRA-301: Etripamil in Atrial Fibrillation Phase 3 Atrial Fibrillation | PHASE3 | Not Yet Recruiting | 2029-01-01 |
| NCT04952610 ↗ | Etripamil Nasal Spray in Patients With Paroxysmal Supraventricular Tachycardia Paroxysmal Supraventricular Tachycardia | PHASE3 | Completed | 2026-04-10 |
| NCT04467905 ↗ | ReVeRA-201: Etripamil in Atrial Fibrillation, Phase 2 Atrial Fibrillation | PHASE2 | Completed | 2023-08-03 |
| NCT04072835 ↗ | Safety Study of Etripamil Nasal Spray for Patients With Paroxysmal Supraventricular Tachycardia. NODE-303 Paroxysmal Supraventricular Tachycardia | PHASE3 | Completed | 2023-01-26 |
| NCT03464019 ↗ | Efficacy and Safety of Etripamil for the Termination of Spontaneous Paroxysmal Supraventricular Tachycardia (PSVT). Paroxysmal Supraventricular Tachycardia | PHASE3 | Terminated | 2023-01-20 |
| NCT03635996 ↗ | Safety Study of Intranasal Etripamil for the Termination of Spontaneous Episodes of Paroxysmal Supraventricular Tachycardia (PSVT). NODE-302 Paroxysmal Supraventricular Tachycardia | PHASE3 | Terminated | 2020-11-13 |
| NCT03353610 ↗ | The PSVT Place Registry.Paroxysmal Supraventricular Tachycardia (PSVT) Registry. Paroxysmal Supraventricular Tachycardia (PSVT) | — | Terminated | 2020-03-16 |
| NCT02296190 ↗ | Efficacy and Safety of Intranasal MSP-2017 (Etripamil) for the Conversion of PSVT to Sinus Rhythm Paroxysmal Supraventricular Tachycardia (PSVT) | PHASE2 | Completed | 2016-12-01 |
Source: ClinicalTrials.gov (U.S. NIH) · active studies first.
Notable events (8-K)
Recent filings
| Form | Filed | Period | Accession |
|---|---|---|---|
| 8-K | 2026-06-15 | 2026-06-10 | 0001104659-26-074025 ↗ |
| 10-Q | 2026-05-13 | 2026-03-31 | 0001104659-26-059752 ↗ |
| 8-K | 2026-05-13 | 2026-05-13 | 0001104659-26-059780 ↗ |
| 10-K | 2026-03-20 | 2025-12-31 | 0001104659-26-032415 ↗ |
| 8-K | 2026-03-20 | 2026-03-20 | 0001104659-26-032427 ↗ |
| 8-K | 2026-01-26 | 2026-01-26 | 0001104659-26-006483 ↗ |
| 8-K | 2026-01-13 | 2026-01-12 | 0001104659-26-003038 ↗ |
| 8-K | 2026-01-06 | 2026-01-06 | 0001104659-26-001099 ↗ |
| 8-K | 2025-12-15 | 2025-12-12 | 0001104659-25-120904 ↗ |
| 8-K | 2025-11-12 | 2025-11-12 | 0001104659-25-109744 ↗ |
| 10-Q | 2025-11-12 | 2025-09-30 | 0001104659-25-109689 ↗ |
| 8-K | 2025-08-12 | 2025-08-12 | 0001104659-25-076468 ↗ |